2023 年第 1 期 第 18 卷

外周血基线红细胞体积分布宽度对老年冠心病患者长期预后的预测价值

Predictive value of peripheral blood baseline red cell volume distribution width on long-term prognosis of elderly patients with coronary atherosclerotic heart disease

作者：李双双1谢翔2吴婷婷2郑颖颖2马依彤2

英文作者：Li Shuangshuang1 Xie Xiang2 Wu Tingting2 Zheng Yingying2 Ma Yitong2

单位：1新疆医科大学第一附属医院呼吸中心，乌鲁木齐830011；2新疆医科大学第一附属医院心脏中心，乌鲁木齐830011

英文单位：1Respiratory Center the First Affiliated Hospital of Xinjiang Medical University Urumqi 830011 China; 2Heart Center the First Affiliated Hospital of Xinjiang Medical University Urumqi 830011 China

关键词：冠心病（冠状动脉粥样硬化性心脏病）；红细胞体积分布宽度；全因死亡；心源性死亡；主要不良心血管事件

英文关键词：Coronaryatheroscleroticheartdisease;Redcellvolumedistributionwidth;All-causedeath;Cardiacmortality;Majoradversecardiovascularevent

• 摘要：

• 目的  探讨外周血基线红细胞体积分布宽度（RDW）对老年冠心病（冠状动脉粥样硬化性心脏病）患者长期预后的预测价值。方法 连续纳入2008年1月至2016年12月在新疆医科大学第一附属医院明确诊断冠心病的老年（年龄≥60岁）患者3 024例并对其进行定期随访，中位随访时间为32个月，最长随访时间达10年，终点事件为全因死亡、心源性死亡(CM)、主要不良心脑血管事件(MACCE)、主要不良心血管事件(MACE)。根据受试者工作特征（ROC）曲线分析获得预测长期全因死亡的基线RDW最佳截断值为13.5%，根据RDW最佳截断值将患者分为低RDW组（＜13.5%，1 915例）和高RDW组（≥13.5%，1 109例）。比较2组患者基线资料和终点事件发生率。调整混杂因素后采用多因素Cox比例风险回归模型分析RDW与患者长期不良预后的关系。结果 2组患者年龄、冠状动脉慢性完全闭塞病变比例、血尿素氮、血肌酐、血尿酸、脂蛋白a水平比较差异均有统计学意义（均P＜0.05）。高RDW组随访期间全因死亡、CM、MACCE、MACE发生率均高于低RDW组，差异均有统计学意义（均P＜0.05）。调整多种混杂因素后，多因素Cox回归分析结果显示，RDW≥13.5%显著增加老年冠心病患者全因死亡（风险比=1.592，95%置信区间：1.160～2.185，P=0.004）、CM（风险比=1.759，95%置信区间：1.217～2.542，P=0.003）、 MACE（风险比=1.351，95%置信区间：1.078～1.692，P=0.009)的发生风险，而不增加MACCE的发生风险（风险比=1.229，95%置信区间：0.994～1.521，P=0.057）。结论 在老年冠心病患者中，基线RDW水平升高可作为长期全因死亡、CM、MACE的独立预测因子。

• Objective To investigate the predictive value of baseline peripheral red cell volume distribution width (RDW) in the long-term prognosis of elderly patients with coronary atherosclerotic heart disease. Methods From January 2008 to December 2016, 3 024 elderly patients (≥ 60 years old) with coronary atherosclerotic heart disease who were definitely diagnosed in the First Affiliated Hospital of Xinjiang Medical University were included and followed-up regularly. The median follow-up duration was 32 months, and the longest was 10 years. The endpoint events included all-cause death, cardiac mortality (CM), major adverse cardio-cerebral vascular events (MACCE), and major adverse cardiovascular events (MACE). According to the analysis of receiver operating characteristic (ROC) curve, the best cutoff value of baseline RDW for predicting long-term all-cause death was 13.5%. According to the best cutoff value of RDW, patients were divided into low RDW group (＜13.5%, 1 915 cases) and high RDW group (≥13.5%, 1 109 cases). The baseline data and the incidence of endpoint events were compared between the two groups. After adjusting for confounding factors, Cox proportional hazard regression model was used to analyze the relationship between RDW and long-term adverse prognosis. Results There were significant differences between the two groups in age, proportion of chronic total coronary artery occlusion, blood urea nitrogen, serum creatinine, serum uric acid and lipoprotein a levels (all P＜0.05). The incidences of all-cause death, CM, MACCE and MACE in the high RDW group were higher than those in the low RDW group during the follow-up period (all P＜0.05). After adjusting for multiple confounding factors, multivariate Cox regression analysis showed that RDW≥13.5% significantly increased the risk of all-cause death (hazard ratio=1.592, 95% confidence interval: 1.160-2.185, P=0.004), CM (hazard ratio=1.759, 95% confidence interval: 1.217-2.542, P=0.003), and MACE (hazard ratio=1.351, 95% confidence interval: 1.078-1.692, P=0.009) in elderly patients with coronary atherosclerotic heart disease, while the risk of MACCE was not increased (hazard ratio=1.229, 95% confidence interval: 0.994-1.521, P=0.057). Conclusion In elderly patients with coronary atherosclerotic heart disease, the increase of baseline RDW level can be used as an independent predictor of long-term all-cause death, CM, and MACE.